Physiological Adaptation Q 263

Correct Answer: D. Surgical intervention

When the vessel ruptures, surgery is the only intervention that can repair it. The techniques used for aneurysm surgery have for long been standardized. 95% of aneurysms are accessible via a small frontotemporal craniotomy centred over the pterion. Only occasional cases, principally aneurysms of the distal anterior cerebral artery and the lower vertebrobasilar trunk, require different surgical approaches.

Option A: Administration of antihypertensive medications can help control hypertension, reducing the risk of rupture. Normalization of blood pressure by hydralazine significantly reduced the incidence of ruptured aneurysms and the rupture rate. There was a dose-dependent relationship between the reduction of blood pressure and the prevention of aneurysmal rupture. Captopril and losartan were able to reduce the rupture rates without affecting systemic hypertension induced by DOCA-salt treatment.

Option B: An aortogram is a diagnostic tool used to detect an aneurysm. An aortogram is an invasive diagnostic test using a catheter to inject dye (contrast medium) into the aorta. X-rays are taken of the dye as it travels within the aorta, allowing clear visualization of blood flow. This way, any structural abnormalities of the aorta will be accurately seen.

Option C: Beta-blockers can slow the heartbeat, thereby decreasing blood pressure. Antihypertensives are used to reduce the rate of rise of the aortic pressure (dP/dt). For acute reduction of arterial pressure, the potent vasodilator sodium nitroprusside is very effective. To reduce dP/dt acutely, administer a beta-blocker intravenously (IV) in incremental doses until a heart rate of 60-80 beats/min is attained. When beta-blockers are contraindicated, as in second- or third-degree atrioventricular block, consider using calcium-channel blockers.